Assessment

• Monitor patient closely during test dose and the first 1–2 hr of each dose for fever, chills, headache, anorexia, nausea, or vomiting. Premedicating with antipyretics, corticosteroids, antihistamines, meperidine, and antiemetics may decrease these reactions. Febrile reaction usually subsides within 4 hr after the infusion is completed

• Assess injection site frequently for thrombophlebitis or leakage. Drug is very irritating to tissues

• Monitor vital signs every 15 min during test dose and every 30 min for 2–4 hr after administrationMeperidine and dantrolene have been used to prevent and treat rigors. Assess respiratory status (lung sounds, dyspnea) daily. Notify physician of changes. If respiratory distress occurs, discontinue infusion immediately; anaphylaxis may occur. Equipment for cardiopulmonary resuscitation should be readily available

• Monitor intake and output and weigh daily. Adequate hydration (2000–3000 ml/day) and maintaining sodium balance may minimize nephrotoxicity

• Monitor CBC, BUN and serum creatinine, and potassium and magnesium levels daily. If BUN and serum creatinine significantly, may need to discontinue or consider switching to cholesteryl sulfate, lipid complex, or liposomal formulation.

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